And now, a soft exoskeleton

A two-fer from Harvard’s Wyss Institute this week. In addition to developing an artificial spleen, researchers there just received a Defense Advanced Research Projects Agency (DARPA) grant for an exoskeleton. What distinguishes this device from other exoskeletons we’ve written about—and makes it of likely more benefit to seniors—is that this so-called “Soft Exosuit” supports the leg muscles with flexible fabric, rather than rigid materials.

If that sounds merely like a longer version of a back support belt, what makes it worth a government grant is the embedded sensor system, which continuously measures the wearer’s position, the suit’s tension, and other factors. No doubt, given the advances in medical monitoring, later versions will be able to track vital signs and detect more detailed aspects of movement.

Indeed, Harvard promises in its press release, “the team will collaborate with clinical partners to develop a medical version of the suit that can help stroke patients, for example, who often experience a slow, inefficient gait and could greatly benefit from walking assistance.”  While the Soft Exosuit should have a promising future as both a diagnostic and an assistive device, it’s still in prototype phase.

The ReWalk exoskeleton, by contrast, has just had “the best performing IPO of the year.” Their stock has been as high as nearly $44 a share and closed today at $33.20.  We wish all involved well, and we hope the cash infusion can help the company develop their device into a less cumbersome–and less expensive–solution.



Technological Solutions for Patient Lifting

One of the greatest dangers for both professional and non-professional caregivers is lifting patients, so much so that a bill was introduced in Congress last year to eliminate manual patient handling. While the bill still awaits passage, there are some interesting alternatives on the technology front.

For the last several years, Japan’s RIKEN Institute, in collaboration with Tokai Rubber Industries, Ltd., has been testing RIBA (Robot for Interactive Body Assistance), a carebot that can lift patients. Its latest iteration, RIBA-II, announced in 2011, can lift a person weighing up to 176 pounds straight from the floor. Unfortunately, it still looks like one of Darth Vader’s stormtroopers crossed with a toy bear.

Another approach is to eliminate the need for lifting entirely. Panasonic is marketing Resyone, a wheelchair that transforms into a flat-bed (not unlike a first class airline seat). It recently earned global safety standard ISO13482 approval, a first for a service robot.

This might work. Image courtesy of Daewoo.

This might work. Image courtesy of Daewoo.

In a robotics advance on the load-bearing belt, South Korea’s Daewoo Shipbuilding and Marine Engineering has created an exoskeleton for their shipyard workers. Already in use, it allows workers to lift materials weighing up to 70 pounds, with plans to increase the load capacity to 200 pounds. It’s not hard to imagine a version that could be employed in hospitals and other medical settings.

Unfortunately, for the foreseeable future, most of these solutions will likely be available at price points that only make them practical for institutions. In the meantime, please remember that the medical literature is filled with grim studies of injuries sustained by caregivers who tried to move bedridden or seated patients. One of those studies offers this cautionary description: “In a perfect world, a ‘safe’ lift would be 51 pounds if the object is within 7 inches from the front of the body, if it is at waist height, if it is directly in front of the person, if there is a handle on the object, and if the load inside the box/bucket doesn’t shift once lifted.” In other words, don’t be afraid to ask for help.



Answering a need without an Exoskeleton

While exoskeletons get the glamour headlines, a paraplegic engineer has quietly solved a more basic problem for those with spinal chord injuries (SCI): a quick and clean way to have a bowel movement. In fact, one famous survey of quadriplegics and paraplegics found that both groups ranked regaining walking movement below regaining bladder/bowel function.

SCI and other neurodegenerative conditions damage the nerves that control the proper functioning of the colon. As wheelchair users and their caretakers know all too well, the only remedy is a time-intensive combination of laxatives and finger stimulation. As an engineer, Erik Fugunt knew that was the very definition of a sub-optimal solution.

Fugunt, injured in a near fatal 2010 motorcycle accident, developed Paraflush, a bidet-like device to aid in bowel cleansing. It does not make life as easy as it once was, but according to the testimonials on his site, it is a great improvement over what those with SCI had been forced to accept.


Exoskeletons for Seniors

As we noted in a previous post, current exoskeletons are problematic because they require the use of crutches for balance. Their target customer appears to be a young-to-middle-aged person who lost lower limb function through an athletic or war-related injury.

imagesBy contrast, the European Union’s Ambient Assisted Living Program has funded research on exoskeletons specifically designed for seniors. Their criteria for successful development of “Exo-legs,” include:

  • Specialised “hands-free” locomotion support/assistance to allow elderly persons to perform their normal, wide-ranging daily activities in an independent manner.
  • Indoor mobility: moving freely within confined spaces giving considerable added value over wheelchairs, be able to perform stand-sit/sit-stand manoeuvres, climb/descend stairs, step over objects, quiet standing, straight walking, turning for centimetric/metric mobility
  • Outdoor mobility: walking/turning on uneven/unstructured surfaces/soft ground, avoiding traffic, crossing roads, taking public transport (buses, trains) to go to rural/distant places, opening/closing doors, using escalators for hectometric/kilometric mobility
  • Cognitive support: provide information/advice to allow decision making when the elderly person has become lost or confused

The project is due to conclude in 2015.



Exoskeletons: Bionic Breakthroughs and Thoughtful Objections

Exoskeletons are touted as the breakthrough that will get those with spinal cord injuries to walk again. An academic prototype, controlled by brain waves, was featured at the beginning of the World Cup, and ReWalk, a commercial version from an Israeli-American company, recently became the first exoskeleton approved by the FDA for daily use in the United States. It’s been sold in other countries for three years already.

Yet nearly every person we’ve seen pictured wearing one was young or at most middle-aged. Worse, exoskeleton users need to balance on crutches, which actually leaves their hands less free than using a wheelchair. In fact, ReWalk’s own developer isn’t a candidate for it, because he can’t use his arms.

Granted, for hiking, as TEDx speaker Amanda Boxtel plans to use the Ekso Bionics’s exoskeleton, the crutches would serve nearly the same function as hiking poles.

Charles Engelbert Photography (970) 379-2005

Amanda Boxtel in Exoskeleton. Is this geniunely as cool as it looks?

As robotics advances, no doubt exoskeletons will become less cumbersome and their batteries will last longer than a reported two-to-three hours. Already since ReWalk’s 2008 prototype, the controller has shrunken from covering half the forearm to the size of a wristwatch. Perhaps lighter, sleeker, stronger versions will make the devices more suitable for those who are too frail to haul themselves on crutches. Perhaps later versions will not require crutches for balance. Most of all, perhaps later versions will cost considerably less than the nearly $60k of these first generation units.

Or perhaps none of that is necessary. Despite Time magazine naming it “among the top 25 best inventions in 2013,” not everyone who uses a wheelchair is exulting over exoskeletons. New Zealand teacher Red Nicholson says, “I have no more desire to be strapped to a robot than I do to go swimming with great white sharks”

Anthropologist and disability rights activist William Peace, author of the blog “Bad Cripple,” questions their value with some very serious number-crunching. What’s truly important for those with SCI, both he and medical experts agree, is to reduce “secondary medical complications caused by an extreme sedentary lifestyle,” such as life-threatening infections caused by bed sores and urinary and bowel dysfunctions.

In contrast to the 60k cost of ReWalk, writes Peace, the price of the required equipment to ensure exercise would be: “$11,000 wheelchair, $500 wheelchair cushion, a $5,000 handcycle, a $4,000 sit ski… Total material costs are a little over $20,000.”

That’s three complete packages for the price of one ReWalk, a device that isn’t even suitable for everyone who uses a wheelchair.